Postoperative Analysis of Macular Perfusional Status in Giant Retinal Tear-Related Retinal Detachments

Rhegmatogenous retinal detachment (RRD) associated with giant retinal tears (GRTs) can cause significant visual impairment due to structural or perfusional macular sequelae. This condition is an acute-onset incident that leads to a full-thickness circumferential retinal tear of at least 90°. Limited data are available concerning the patients´ long-term perfusional status after successful surgery for GRTs with maculaoff RRD. This chapter examines the long-term outcomes of eyes treated with varying degrees of GRT-associated RRD extensions and compares them with those of two control groups. The surgical group was subdivided according to GRT-associated RRD extension as follows: eyes with extension of <180° and eyes with extension > of >180°. The eyes were further classified according to whether complementary 360° scleral buckle (SB) placement was required. Postoperative optical coherence tomography (OCT) demonstrated that 33.3% of the eyes had abnormal foveal contours, 39.4% had ellipsoid zone (EZ) disruption, 2 had dissociated optic nerve fiber layer (DONFL) defects, and 45.4% had external limiting membrane (ELM) line discontinuities. OCT angiography (OCT-A) revealed abnormal perfusion indices in surgically treated eyes (p<0.0001). Postsurgical best-corrected visual acuity (BCVA) was negatively correlated with the superficial foveal avascular zone area, superficial parafoveal vessel density, and central subfoveal thickness but positively correlated with the choriocapillaris flow area (CFA). Moreover, eyes treated surgically for GRT-associated RRD had multiple structural alterations reflected by spectral-domain OCT biomarkers and OCT-A perfusional findings correlated with visual outcomes. Despite successful retinal reattachment without proliferation, management of GRT-associated RRD remains challenging.

Keywords: Brilliant Blue G dye, Choriocapillaris flow area, Choriocapillaris subfoveal plexus, Deep vascular plexus, Dissociated optic nerve fiber layer defects, Ellipsoid zone, Epiretinal membrane proliferation, External limiting membrane, Foveal avascular zone, Giant retinal tears, Pars plana vitrectomy, Perfluoropropane gas, Postoperative perfusion indices, Proliferative vitreoretinopathy, Retinal pigment epithelium, Rhegmatogenous retinal detachment, Scleral buckle, Superficial vascular plexus, Trypan blue, Vessel density.